Synopsis
Stabilise suspected Mallory-Weiss bleeding, use risk-stratified early endoscopy and treat ongoing haemorrhage while addressing the precipitating retching safely.
- A Mallory-Weiss lesion is a longitudinal mucosal laceration near the gastro-oesophageal junction produced by a sudden pressure gradient during retching, vomiting, coughing or straining.
- The typical history is repeated non-bloody emesis followed by fresh haematemesis, but the sequence is absent in some patients and cannot replace endoscopy.
- Most tears stop bleeding spontaneously, yet active arterial oozing, shock, coagulopathy or major comorbidity can make haemorrhage clinically important.
Key red flags
Several episodes of forceful non-bloody vomiting are followed by fresh haematemesis, often with less pain than the amount of blood initially suggests.
Investigation priorities
Recognise shock and response to resuscitation in real time.
Management branches
Haematemesis or melaena occurs after retching, with or without circulatory compromise.
- Assess airway, breathing and circulation, call for senior help, place appropriate large-bore IV access and monitor continuously when bleeding is severe.
- Send urgent bloods and group-and-screen, begin balanced crystalloid while blood is prepared, and activate the major-haemorrhage protocol for uncontrolled bleeding or shock.
Key medicines
Proton pump inhibitor after endoscopyUse the current NICE CG141 regimen for non-variceal bleeding with endoscopic stigmata or a licensed oral course for coexisting acid injury; route and intensity are selected from the endoscopic finding and local protocol.
Antiemetic therapySelect a licensed antiemetic and adult dose from the current BNF according to the likely cause, route available and comorbidity, using the shortest effective course and correcting dehydration or electrolyte disturbance.